Objective:

To evaluate the association between syphilis infection and cardiovascular outcomes in patients without preexisting cardiovascular disease.

Key Findings:

• Patients with syphilis had higher rates of myocardial infarction (7% vs 4%), ischemic stroke (10% vs 6%), hemorrhagic stroke (2% vs 1%), aortic aneurysm or dissection (3% vs 1%), and peripheral artery disease (6% vs 4%).
• Syphilis was independently associated with increased risk of multiple cardiovascular outcomes after multivariable adjustment.
• Markedly elevated mortality risk associated with syphilis (hazard ratio, 5.80; 95% CI, 3.81–8.82).
• No significant differences observed for heart failure, atrial fibrillation, aortic regurgitation, or venous thromboembolism.
• Tertiary syphilis was linked to increased cardiovascular risks, while primary or secondary syphilis showed no associations.

Interpretation:

Syphilis infection is associated with increased risks of several adverse cardiovascular outcomes, particularly affecting vascular tissues.

Limitations:

• Retrospective design may introduce bias.
• Potential residual confounding.
• Reliance on diagnostic codes for syphilis identification.
• Lack of data on treatment status or laboratory measures.

Conclusion:

Early detection and treatment of syphilis may be crucial, and cardiovascular risk assessment should be integrated into syphilis management.